Disorders - Psychosis Disorders
Robles, Olalla, Zabala, Arantzazu, Bombin,
Igor, Parellada, Mara, Moreno, Dolores, Ruiz-Sancho, Ana, Arango, Celso
The primary purpose of this study was to compare changes in cognition in early-onset psychosis after 6-months treatment with
quetiapine or olanzapine. This is a randomized, single-blind, 6-month study in 50 adolescents with a diagnosis of early-onset psychosis. Patients
were randomized to quetiapine (n = 24) or olanzapine (n = 26). A thorough neuropsychological battery was administered at baseline and after 6-month
treatment. Out of the total sample included in the study, 32 patients completed at least 6-months treatment with the assigned medication (quetiapine,
n = 16; olanzapine, n = 16). No changes were observed in cognitive performance after 6-month treatment with quetiapine or olanzapine. Although some
trends toward cognitive improvement were observed for the olanzapine group after 6-month treatment, neither group showed statistically significant
gains. Furthermore, there was no evidence of any differential efficacy of olanzapine or quetiapine on cognitive improvement in this sample of
adolescents with psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Schizophrenia
Bulletin, 37(Suppl 2) : 405-415
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Schennach-Wolff, R., Jager, M., Mayr, A., Meyer, S., Kuhn, K. U., Klingberg, S., Heuser, I., et-al
Background: To evaluate the predictive validity of early response
compared to other well-known predictor variables in acutely ill first-episode patients. Methods: 112 patients were treated with a mean dosage of
4.14. mg ((plus or minus) 1.70) haloperidol and 112 patients with a mean dosage of 4.17. mg ((plus or minus) 1.55) risperidone for a mean inpatient
treatment duration of 42.92. days ((plus or minus) 16.85) within a double-blind, randomized controlled trial. Early response was defined as a
(greater-than or equal to) 30% improvement in the PANSS total score by week 2, response as a (greater-than or equal to) 50% reduction in the PANSS
total score from admission to discharge and remission according to the consensus criteria. Univariate tests and logistic regression models were
applied to identify significant predictors of response and remission. Results: 52% of the patients were responders and 59% remitters at discharge.
Non-remitters at discharge were hindered from becoming remitters mainly by the presence of negative symptoms. Univariate tests revealed several
significant differences between responders/non-responders and remitters/non-remitters such as age, severity of baseline psychopathology as well as
the frequency of early response. Both early response (p < 0.0001) and a higher PANSS positive subscore at admission (p = 0.0002) were identified as
significant predictors of response at discharge, whereas a shorter duration of untreated psychosis (p = 0.0167), a lower PANSS general
psychopathology subscore (p < 0.0001), and early treatment response (p = 0.0002) were identified as significant predictors of remission. Conclusion:
Together with the finding that early response is a significant predictor of response and remission, the relevance and predictive validity of negative
and depressive symptoms for outcome is also highlighted. (copyright) 2010 Elsevier B.V.
European Neuropsychopharmacology, 21(5) : 370-
378
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Sevy, S., Robinson, D. G., Sunday, S., Napolitano, B., Miller, R., McCormack, J., Kane, J.
The purpose of this study is to compare the efficacy
of olanzapine and risperidone for the acute treatment of first-episode schizophrenia patients with cannabis use disorders. This secondary analysis of
a previously published study included 49 first-episode patients with a diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective
disorder and a co-occurring lifetime diagnosis of cannabis use disorders randomly assigned to treatment with either olanzapine (n = 28) or
risperidone (n = 21) for 16. weeks. The olanzapine group did not differ significantly from the risperidone group for initial response rates of
positive symptoms, and rates of cannabis use or alcohol use during the study. Positive symptoms and the Scale for Assessment of Negative Symptoms
(SANS) global asociality-anhedonia scores improved over time but did not differ between study medications. In both groups, cannabis use during the
study was higher in patients who used cannabis within three months of the admission. Thus, our results suggest that olanzapine and risperidone had a
similar initial efficacy on psychotic symptoms and substance use in first-episode patients with co-occurring cannabis use disorders. If clinicians
are choosing between olanzapine versus risperidone treatment for this population, their decision should be based upon factors other than symptom
response and short-term substance misuse. (copyright) 2011 Elsevier Ltd.
Psychiatry Research, 188(3) : 310-314
- Year: 2011
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Thorup, Anne, Petersen, Lone, Jeppesen, Pia, Nordentoft, Merete
Background: Aim:
Method: Results: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of
specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was
investigated in the 'OPUS' study by analysing data concerning quality of life.We aimed to investigate the 'quality of life from patients'
perspective' among a cohort of young adults with a first-episode psychosis at the time of treatment initiation and after two years. Especially, we
were interested in analysing if there were any significant effects on the subjective quality of life of receiving an intensive psychosocial assertive
community treatment called 'OPUS' compared to standard treatment (ST).This study is part of the Danish 'OPUS' trial, a randomised controlled
trial (RCT) comparing 'treatment as usual' (standard treatment, ST) with 'OPUS' treatment. The Lancashire Quality of Life Profile (LQoLP), which
is a combined objective and subjective instrument, was administered at baseline and after two years of treatment, N=280.The intensive 'OPUS'
treatment did not affect the quality of life measured by Lancashire QoLP in a significantly different way from the standard treatment (ST). There
were no significant differences in quality of life between the ST group and the OPUS group concerning the 9 life domains. Quality of life correlated
with psychopathology (both psychotic and negative symptoms) to a minor extent and more strongly with the affective balance and level of self-
esteem.
Schizophrenia Research, 116(1) : 27-
34
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
vanVeelen, Nicoletta M. J., Grootens, Koen P., Peuskens, J., Sabbe, B. G.
C., Salden, Miriam E., Verkes, R. J., Kahn, Rene S., Sitskoorn, Margriet M.
Background: Method: Results: Conclusion: Cognitive deficits are a core feature in schizophrenia. Cognitive deficits appear to be present
at the onset of schizophrenia and persist after remission of psychotic symptoms. As cognitive deficits are associated with poor functional outcome,
they form an important focus of treatment. There are relatively few head-to-head comparisons of the effects of second generation antipsychotics on
cognition in recent onset schizophrenia. This is the first study to compare the effects of a short term treatment of olanzapine versus ziprasidone on
cognitive functioning in recent onset schizophrenia. An earlier study conducted in chronic patients revealed an enhancement of cognition after
treatment for both agents, but the extent of improvement was not significantly different between ziprasidone and olanzapine.Patients with recent
onset schizophrenia with limited previous exposure to medical treatment underwent a double blind randomized controlled treatment trial. Fifty-six
patients completed the neuropsychological testing procedure prior to randomization and after eight weeks of treatment and were included in the
analysis. We tested cognitive functioning in general and verbal memory in particular. We calculated a single unweighted composite score based on nine
cognitive tests to determine general cognitive functioning.Cognition appeared enhanced after treatment, but was not significantly different between
treatment groups, neither for the verbal memory measures, nor for the neurocognitive composite score. Furthermore, cognitive enhancement did not
correlate to clinical improvement.Cognitive deficits are not a reason for preferentially prescribing one of the two second generation antipsychotics
tested over the other.\r(c) 2010 Elsevier B.V. All rights reserved.
Schizophrenia Research, 120(1-3) : 191-198
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Preti, Antonio, Cella, Matteo
As an extension of
the early intervention in psychosis paradigm, different focused treatments are now offered to individuals at ultra high risk of psychosis (UHR) to
prevent transition to schizophrenia, however the effectiveness of these treatments is unclear. A systematic literature search in PubMed/Medline and
PsycINFO was performed to derive information on randomized control trials (RCTs) in UHR samples. Seven reports were identified detailing results from
five independent RCT studies. Two studies used antipsychotic drugs (one in combination with cognitive behavior therapy); one study employed cognitive
therapy; one study used a two-year program of intensive community care with family psychoeducation; one study assessed the effectiveness of 3-months
omega-3 polyunsaturated fatty acids (Omega-3 PUFAs) supplementation. Intensive community care and the Omega-3 PUFAs supplementation were effective in
reducing the transition to psychosis at 12 months. Overall, rates of transition to psychosis at 1 year were 11% for focused treatment groups (n=180)
and 31.6% for control UHR groups (n=157). Receiving any of the focused treatment was associated with a lower risk of developing psychosis if compared
with no treatment or treatment as usual (Relative Risk=0.36; 95%CI: 0.22-0.59). The available evidence at 2/3 years follow-up indicates that the
effects of focused treatments are not stable after intervention cessation and when treatment is delivered over a restricted time (e.g. 6 months or
less), it may achieve only a delay in psychosis onset. Due to the heterogeneity in the interventions considered, the current results do not allow
recommendation for any specific treatment.\rCopyright © 2010 Elsevier B.V. All rights reserved.
Schizophrenia Research, 123(1) : 30-
36
- Year: 2010
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Nordentoft, M., Ohlenschlaeger, J., Thorup, A., Petersen, L., Jeppesen, P., Bertelsen,
M.
BACKGROUND: The
effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and
standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of
institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed
days and days in supported housing. METHOD: A total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in
a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or
hospital-based rehabilitation. RESULTS: It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in
psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment
spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based
rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be
evaluated. CONCLUSIONS: The study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated
with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in
first-episode psychosis.
Psychological Medicine, 40(10) : 1-
8
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Muller, Norbert, Krause, Daniela, Dehning, Sandra, Musil, Richard, Schennach-Wolff, Rebecca, Obermeier, Michael, Klauss, Volker, Schwarz, Markus J., Riedel, Michael
Recent trials support the hypothesis of the role of
inflammation in the pathogenesis of schizophrenia. The overall therapeutic benefit of anti-inflammatory medication, in particular cyclo-oxygenase-2
(COX-2) inhibitors in schizophrenia, is still controversial. There are suggestions that therapy with COX-2 inhibitors may influence the early stages
of the disease. Taking these findings into account, we conducted a double-blind, placebo-controlled, randomized trial of celecoxib augmentation to
amisulpride treatment in patients with a first manifestation of schizophrenia. Forty-nine patients diagnosed with schizophrenia were randomly
assigned. They were treated either with amisulpride (200-1000 mg) plus celecoxib (400 mg) or amisulpride (200-1000 mg) plus placebo. Inclusion
criterion was the diagnosis of schizophrenia during the past two years according to DSM-IV. The trial lasted six weeks. At weekly intervals an
assessment of the psychopathology was performed using the Positive and Negative Symptom Scale (PANSS) and the Global Clinical Impression Scale (CGI).
A significantly better outcome was observed in the patient group treated with amisulpride plus celecoxib compared to the group with amisulpride plus
placebo (PANSS negative: p=0.03; PANSS global; p=0.05 and PANSS total: p=0.02). In addition, ratings by the CGI scale during therapy with amisulpride
and celecoxib showed a significantly better result (p< or =0.001). A significantly superior therapeutic effect could be observed in the celecoxib
group compared to placebo in the treatment of early stage schizophrenia. This is the first time an improvement in patients' negative symptoms has
been demonstrated with celecoxib. In future, further trials are needed to investigate the effect of COX-2 inhibitors on prodromal and negative
symptoms of schizophrenia.\rCopyright 2010 Elsevier B.V. All rights reserved.
Schizophrenia Research, 121(1-3) : 118-
124
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Other biological interventions
Meltzer,
Herbert Y., Bobo, William V., Lee, Myung A., Cola, Philip, Jayathilake, Karuna
Clozapine has been shown to be superior to typical neuroleptic drugs for treating positive symptoms in treatment-resistant
(TR) schizophrenia. Long-term data from randomized clinical trials comparing clozapine with typical neuroleptics in non-TR schizophrenia are rare. We
previously reported that clozapine was superior to typical neuroleptic drugs in some domains of cognition in recent onset non-TR schizophrenia. We
now present data on psychopathology and quality of life from this randomized, flexibly dosed, 24-month study of clozapine vs. typical neuroleptics in
non-TR schizophrenia patients. Both treatments produced significant improvement in measures of psychopathology, quality of life, and global function,
with minor exceptions. There was no difference in extrapyramidal side effects between the patients treated with clozapine or typical neuroleptics.
However, significantly more relapse/rehospitalization drop-outs occurred in the typical neuroleptic group. Two patients treated with typical
neuroleptics, but none treated with clozapine, became non-responsive to treatment. Clozapine was associated with significantly greater weight gain.
Clozapine and typical neuroleptic drugs appear to produce equivalent improvement in psychopathology in patients with non-TR schizophrenia. Clozapine
may be more effective than typical neuroleptics for treatment retention and prevention of relapse, but it produces more severe metabolic side
effects. These considerations should be taken into account in decisions of how best to utilize clozapine in the treatment of schizophrenia.
\rCopyright 2010 Elsevier Ireland Ltd. All rights reserved.
Psychiatry Research, 177(3) : 286-
293
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Levkovitz, Yechiel, Mendlovich, Shlomo, Riwkes, Sharon, Braw, Yoram, Levkovitch-Verbin, Hana, Gal, Gilad, Fennig, Shmuel, Treves, Ilan, Kron, Shmuel
Background: Objective: Method: Results: Conclusions: Trial Registration:
Current antipsychotics have only a limited effect on 2 core aspects of schizophrenia: negative symptoms and cognitive deficits. Minocycline is a
second-generation tetracycline that has a beneficial effect in various neurologic disorders. Recent findings in animal models and human case reports
suggest its potential for the treatment of schizophrenia. These findings may be linked to the effect of minocycline on the glutamatergic system,
through inhibition of nitric oxide synthase and blocking of nitric oxide-induced neurotoxicity. Other proposed mechanisms of action include effects
of minocycline on the dopaminergic system and its inhibition of microglial activation.To examine the efficacy of minocycline as an add-on treatment
for alleviating negative and cognitive symptoms in early-phase schizophrenia.A longitudinal double-blind, randomized, placebo-controlled design was
used, and patients were followed for 6 months from August 2003 to March 2007. Seventy early-phase schizophrenia patients (according to DSM-IV) were
recruited and 54 were randomly allocated in a 2:1 ratio to minocycline 200 mg/d. All patients had been initiated on treatment with an atypical
antipsychotic < or = 14 days prior to study entry (risperidone, olanzapine, quetiapine, or clozapine; 200-600 mg/d chlorpromazine-equivalent doses).
Clinical, cognitive, and functional assessments were conducted, with the Scale for the Assessment of Negative Symptoms (SANS) as the primary outcome
measure.Minocycline was well tolerated, with few adverse events. It showed a beneficial effect on negative symptoms and general outcome (evident in
SANS, Clinical Global Impressions scale). A similar pattern was found for cognitive functioning, mainly in executive functions (working memory,
cognitive shifting, and cognitive planning).Minocycline treatment was associated with improvement in negative symptoms and executive functioning,
both related to frontal-lobe activity. Overall, the findings support the beneficial effect of minocycline add-on therapy in early-phase
schizophrenia.clinicaltrials.gov Identifier: NCT00733057.\rCopyright 2010 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 71(2) : 138-
149
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Grootens, K. P., van Veelen, N. M. J., Sitskoorn, M. M., Sabbe, B. G. C., Peuskens, J., Buitelaar, J. K., Verkes, R. J., Kahn, R.
S.
Introduction: To enhance functional outcome in schizophrenia improvement of cognitive symptoms is crucial. Experimental
procedures: Using a comprehensive test battery, this follow-up examines cognitive effects in patients with recent-onset schizophrenia after a change
of medication following insufficient clinical response and intolerance. Results: After eight weeks cognitive outcomes had not improved in the
patients having switched from olanzapine to ziprasidone (n=11; mean dose 136 mg) nor in those having switched from ziprasidone to olanzapine (n=10;
mean 16 mg), while the symptoms of patients maintaining olanzapine (n=18; mean 10.9 mg) or ziprasidone (n=18; mean 88.9 mg) treatment had not
improved further. Discussion: The findings suggest that also in early-stage schizophrenia the antipsychotics tested affect cognitive symptoms
similarly. (copyright) 2010 Elsevier B.V. and ECNP.
European Neuropsychopharmacology, 20(12) : 907-
912
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Gafoor, Rafael, Landau, Sabine, Craig, Tom K. J., Elanjithara, Thomas, Power, Paddy, McGuire, Philip
Objective: To compare the efficacy and adverse effect profiles of 2 widely used
atypical antipsychotics in the short-term phase of first-episode schizophrenia in patients who were treatment-naive. A secondary objective was to
establish the effective dose of these drugs in this context. Methods: A total of 72 patients with a first episode of schizophreniform psychosis
(schizophrenia spectrum disorder) with less than 2 weeks of exposure to antipsychotic medication were randomized to quetiapine or risperidone in a
single-blind 12-week controlled trial. Psychopathologic diagnoses and adverse effects were assessed by blinded raters at 4 weekly intervals.
Medication was administered by a specialized clinical team following dosing guidelines. Data were analyzed using an intention-to-treat paradigm.
Results: Both quetiapine and risperidone were associated with a reduction in immediate symptoms and relatively few adverse effects other than weight
gain. There was no statistically significant difference between the 2 compounds in adverse effects, relative efficacies, or adherence to treatment.
The median (SD) time to cessation for patients randomized to quetiapine was 65.3 (41.85) days and that for risperidone was 82.5 (44.88) days. There
was no statistically significant difference between time to discontinuation for the 2 compounds. The mean daily doses prescribed were 375 mg of
quetiapine and 2.72 mg of risperidone. Conclusions: Quetiapine and risperidone are both effective treatments in first-episode schizophrenia at doses
lower than those used in patients with long-term schizophrenia and are similar in efficacy and the incidence of adverse effects. (PsycINFO Database
Record (c) 2010 APA, all rights reserved) (journal abstract)
Journal of Clinical Psychopharmacology, 30(5) : 600-
606
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)